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With insurance deadline looming, some can't wait for coverage

After struggling with the online marketplace, Bobby and Karen Cox now have a paper application. The Coxes, both uninsured, have been using their savings to pay medical bills since Bobby was diagnosed with lung cancer — just days after the marketplace opened.

JIM DAMASKE | Times

After struggling with the online marketplace, Bobby and Karen Cox now have a paper application. The Coxes, both uninsured, have been using their savings to pay medical bills since Bobby was diagnosed with lung cancer — just days after the marketplace opened.

When they were locked out of the troubled federal insurance website in its first week, Karen and Bobby Cox didn't panic. The uninsured couple from Dunedin figured they could wait until the site got fixed.

But just days after that first attempt, the Coxes lost the luxury of waiting.

Bobby Cox, a 60-year-old construction worker, learned in October he has advanced lung cancer. Now as they deal with his diagnosis, the Coxes feel no closer to securing insurance coverage than they were on the first day they logged onto healthcare.gov, the now infamous centerpiece of the Affordable Care Act.

"I don't want any bills hanging over her when I'm gone," said Bobby, who starts chemotherapy this week. They're drawing on modest savings and impressive bargain-hunting skills until they can get insurance.

The Coxes are among the millions of Americans running out of time to get insurance coverage that starts Jan. 1. Though the federal website has improved since its debut, problems persist both for consumers and for insurers, which have been getting incorrect enrollee reports from the government.

Administration officials say significant upgrades should now be in place to allow at least 50,000 users at any given moment — the level of traffic the site was supposed to have handled on its first day. No one can guarantee that the system will work well enough to withstand the rush of consumers racing to meet the Dec. 23 deadline for coverage starting Jan. 1.

What's more, the Monday after Thanksgiving is traditionally a very busy day for open enrollment, and promises that healthcare.gov would be working by late November could make demand now especially steep.

Much has been made of the fact that younger, healthier consumers are needed in order to make marketplace insurance viable for the private insurers behind it. The technical challenges are thought to be discouraging such customers.

But people like the Coxes can't wait for things to get easier.

• • •

Federal officials say they are working on ways around healthcare.gov, including allowing consumers who are eligible for subsidies to sign up directly with insurers rather than using the government portal. Web-based brokers, such as ehealthinsurance and GoHealth, are displaying many — though not all — of the exchange plans.

But at this point, the general advice to consumers is the same as it was in early October:

Keep trying heathcare.gov. If you can't see the plans there, look for them on private insurers' websites. Call the toll-free help line — though operators also must work through the website. Call a navigator or a specially trained counselor at one of the community health centers. Make an appointment with independent insurance brokers, though they, too, must deal with the website.

It may sound like a lot of options, but in practice, it's a frustrating process, especially for people who have never made a purchase as complicated as health insurance. Those who've gone through it successfully say it required patience — sometimes a lot of it.

"I hope people are persistent and things continue to improve," said Washington and Lee University law professor Timothy Jost, an expert on the Affordable Care Act.

As the Dec. 23 deadline gets closer, those who can afford it — and are desperate — may want to buy a plan, without a subsidy, directly from an insurer, said Gary Claxton, a Kaiser Family Foundation expert on the health exchanges. If you discover before open enrollment ends March 31 that you're eligible for a subsidy, you can cancel the plan you bought and enroll in a subsidized policy, he said.

• • •

The Coxes have spent the last month on other calculations. They called around for the best cash prices on imaging and biopsies and have been dipping into their savings to cover the costs: PET scan, $1,200; needle biopsy, $500; anesthesia, $250.

Karen, still in the purple scrubs she wears as a medical assistant, pulled out a blue folder stuffed with quotes and appointment reminders one evening last week. Bobby, sitting next to her at the kitchen table, glanced at the folder then looked away.

"I let her handle all that," said Bobby, with a wave of his hand. He bent over at his waist and let out a deep cough.

Karen, 62, can't afford the insurance offered where she works. Bobby hasn't had much of a shot at coverage in the last five years. A foreman, he's had a journeyman schedule since the economy crashed, going from one job to the next. Shortly before his diagnosis, he found a new job with a construction company, but wouldn't have been eligible for coverage for a full year. He's too sick to work now.

The couple believes the insurance exchange created under the Affordable Care Act could be their answer. Their income is likely low enough to qualify them for a sizable subsidy.

But after being stymied by the website, Karen didn't get much further with the toll-free help line that President Barack Obama has urged Americans to call. The operator was polite but could only promise to mail a paper application. It took two weeks to arrive.

"It's very complicated," said Karen, pulling it out of her folder. "You almost have to be a lawyer to understand it."

She made an appointment with an insurance broker, who told her to call back after Thanksgiving, in hopes healthcare.gov will be running more smoothly.

But she isn't stopping there. One doctor's office suggested maybe Bobby could get into a Medicaid program for the seriously ill. So she's collecting documents for that application. The cancer specialty group indicated he might qualify for charity care. So she has a file for that option as well. Bobby has qualified for Social Security disability, though the first check won't come until around April. And it would take two years under current law before his disability would render him eligible for Medicare — past the prognosis he has been given.

The Coxes asked the doctor if they could wait until Jan. 1 to start Bobby's treatment. The doctor said no.

Karen said that though the cancer isn't curable, treatment could extend his life beyond the doctor's initial estimate of around 18 months.

At the end of three months, doctors will take another scan to see how the chemotherapy is working on the cancer, which is in both lungs.

At that point, said Bobby, he might refuse more cancer treatments even if he has insurance.

"If it's spreading, I'm stopping," he said. "It does scare me. But I have to deal with it."

Jodie Tillman can be reached at jtillman@tampabay.com or (813) 226-3374.

Getting coverage? Mostly no.

More than a dozen local residents talked with the Tampa Bay Times about their efforts to buy coverage through the marketplace. Though about 3,500 Floridians have been able to buy private coverage on the exchange, that number is dwarfed by the number of uninsured people in the state. They told stories of watching the website crash just as they typed in all their personal information, of calling the help center and learning the operators were stuck, too. One had a success. Here are some of their stories:

Julianne Craft, 63, Safety Harbor

Just after learning she qualified for $321 a month in subsidies, Craft's computer screen froze and she was locked out of the healthcare.gov site. When she later returned to the site and re-entered the same information, she was told she qualifies for no subsidy. The website has also given her two different identification numbers.

Though her husband has Medicare, Craft has gone uninsured since their home-building business tanked more than five years ago. Not long ago, she fell at a remodeling job and suffered a compound leg fracture — and a $35,000 medical bill. They pay what they can.

"I voted for Obama because of this health care law," said Craft, who has also called the help line multiple times. But now, "it's all messed up, and it's so frustrating."

Ann Orr, 50, New Port Richey

On two occasions Orr spent 90 minutes on the phone with the call center, repeating the same information — only to be told on a follow-up phone call that she'd have to do it again because the computer had crashed.

Orr said she had to quit her job at a doctor's office because of injuries suffered in a car accident. She's applying for disability but, without insurance, she has been putting her doctor visits and $200-a-month drug regimen on a credit card.

"I'm going broke real quick," said Orr, who won't use the website because she fears it's not secure.

Pat Chevalier, 62, St. Petersburg

Trying healthcare.gov in early October, Chevalier kept getting a message that read, "invalid password." So she tried the toll-free help line. She gave all of her financial information over the phone and was told her application was submitted and she would hear about her subsidy soon. She never did.

Despite additional phone calls, she has never received confirmation of her application. "The people answering the phone can't do anything because they're dependent on the website," she said.

Chevalier retired from the social work field in August. She couldn't afford COBRA to keep her health benefits but figured she'd go without insurance until she could apply through healthcare.gov. "I'm anxious because I'm not sure," she said. "I'm thinking I may have made a mistake in retiring."

Jim Chayka, 63, Largo

A custodian, Chayka hasn't had coverage in six years. He's relatively healthy, though his bum knee will likely require surgery soon. He tried to get through to healthcare.gov in October, then again in November after hearing that things were improving.

"It was a rainy morning, and I was getting ready to go to the gym, and I said, 'You know, I'm going to get on this again,' " said Chayka. "All of a sudden I went, 'Whoa. Am I going to get through this?' "

He did.

He picked a Humana silver plan, which, after his subsidy, will cost about $91 a month. The application took him about an hour — despite the fact that his computer's mouse didn't work.

"If I'd had my mouse," he said, "it'd have gone a lot quicker."

Jodie Tillman, Times staff writer

This article has been updated to reflect the following correction: Ann Orr, a 50-year-old New Port Richey resident seeking insurance coverage through healthcare.gov, had to stop working because of back and neck pain associated with a car accident. A previous version gave a different reason.

With insurance deadline looming, some can't wait for coverage 11/30/13 [Last modified: Tuesday, December 3, 2013 12:40pm]

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